"Emotions and health are critically connected on every level," said Ryan Niemiec, a psychologist and behavioral consultant with the Primary Care and Prevention Center in St. Louis. "Emotions can cause physical illness, make it worse, or they can maintain an illness - keep it from (improving) because the person is stuck in some emotion. Or they can aid in recovery.

"It's artificial to say there's a separation. Anything that happens in the body happens in the mind, and anything that happens in the mind happens in the body."

While doctors and scientists differ on how the connection works, they all agree that mind and body affect each other.

Dr. Michael LeFevre is a professor of family medicine at the University of Missouri at Columbia. Medicine is recognizing that illness is multifaceted, he says.

"Wellness occurs in four dimensions," he said: biologically, psychologically, socially and spiritually.

"In order to feel a state of good health, you have to feel well in all of those dimensions. It's actually uncommon for an illness to be experienced in only one of those dimensions."

An example is rheumatoid arthritis. It's a biological disease that occurs when your immune system attacks your joints. "Then you're in pain and you're down about being in pain all the time, then you're not sleeping well, which affects your relationships with other people, and that makes you more depressed, and that makes the arthritis worse," LeFevre said.

"Eventually you ask, 'God, why me?' and that can affect the spiritual realm as well."

But finding hard data to support the link between emotions and illness can be difficult.

Dr. Arthur Labovitz, chief of cardiology for St. Louis University School of Medicine, explains why stress is not listed among the risk factors for heart disease.

"The data linking stress to heart disease is relatively soft," Labovitz says. "We'd like to think that being happy and a nice person would equal long life and heart health. But that's not necessarily the case."

The American Heart Association agrees with him, stating: "Managing stress makes sense for your overall health. But current data don't yet support specific recommendations about stress reduction as a proven therapy for cardiovascular disease."

Two people can have identical physical conditions and get a similar emotional jolt. One will have a heart attack and the other won't, Labovitz said, and there's no way to explain why.

Still, doctors see examples where emotions and physical health are linked, he says. One indication is a newly recognized condition called "broken heart syndrome." Doctors call it acute stress cardiomyopathy.

Someone gets bad news. That stuns the heart and the person has all of the symptoms of a heart attack, including chest pains, shortness of breath and fluid in the lungs. The heart can stop working and the person can die.

However, the condition can be cured with bed rest, and often there's no permanent damage.

Scientists are still trying to explain it. The explanation involves surging stress hormones disrupting the heart somehow.

Despite the lack of studies, there's enough evidence to take emotion into account when dealing with illness, said Dr. James O'Keefe, an author and cardiologist practicing in Kansas City, Mo. Experts agree that when your mood is good you feel better physically, and when your mood is bad you feel worse physically, he said.

"Emotional state plays a very big role in overall health, especially when recovering from a health crisis like major surgery," he said. "Optimistic people tend to recover more quickly, stay healthier and are more vigorous - not to mention more happy in the long run.

"Emotional support from family, friends, religion, pets, etc., helps to get a person back to a positive state of mind. I tell my patients that they need to be sure to invest time and energy into cultivating good relationships with family and friends. In the big picture, nothing is more important both for health and happiness, and quality and quantity of life."

Psychologist Niemiec is a therapist with the St. Louis Behavioral Medicine Institute, where he works alongside physicians to help people get in touch with feelings that affect their health. The institute grew as a response to theories on people's moods affecting their physical health.

But even that specialized agency hasn't answered the question: What comes first, the bad emotions or the illness? Is someone cranky and scowling because he's sick, or is he sick because he's cranky and scowling?

Niemiec says the conventional wisdom is that it doesn't matter.

"It can be a vicious cycle," he said.

For example, in the case of someone who has just learned that he has diabetes, instead of exercising, he'll sit more, eat the wrong foods, mope and, in turn, make the diabetes worse.

"They just kind of feed off each other; that happens a lot with chronic illness," Niemiec says.

On the other hand, headaches, body aches and other stress-related reactions can result from bad emotions.

And while some people simply aren't happy regardless of their life situation, there's no clear physical link, such as genetics, as to why that happens, he said.

In any event, Niemiec offered these suggestions:

• If you're tired of feeling lousy, ask that your doctor refer you to a therapist. You need to learn how great an impact bad emotions have on your life. "We look at their social life, their work life, their school life, recreational life; how things are going in the present moment."

Vigilance is needed, because while many folks disregard bad emotions as something that will pass, that can backfire. Sadness can evolve into depression. Fear evolves into anxiety. Anger can evolve into hostility. Guilt can evolve into shame and addiction.

"If it's having an impact in any of those levels, it needs to be addressed," says Niemiec.

• Exercise has been proven to elevate mood and make people healthier. It's also a good way to blow off steam, Niemiec said. Having explosive emotional outbursts is unhealthy for both the person who's exploding and her targets, he said, noting that even the act of punching the pillow or screaming in the car isn't healthy.

"That becomes practice and simply gets you ready to do it when you're not in private," he said. "It's better to learn to get in touch with the negative emotions and deal with them."

• Meditation is a practice of both relaxation and exploration, he said.

Niemiec sends people to meditation facilities, especially those that practice "mindfulness therapy." Mindfulness is meditation that addresses the moment; it's getting in touch with the state of bad emotions, as well as detecting triggers that set them off.

Finally, Niemiec says some people are perfectly happy with their role as a curmudgeon. "There are lots of factors that bring a person to be that way. I don't know if there's a curmudgeon gene, but certainly there are predispositions for having certain types of attitudes."

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